Report a diagnosis, exposure or isolation due to COVID-19
If you have been diagnosed, exposed or isolated due to COVID-19 (Corona Virus), please complete this form and a Health Services nurse will contact you within 1hr for follow up.
Name: *
Your answer
Are you a student/staff/faculty? *
If you are not self reporting, who is the person you are reporting?
Name of the person being reported: *
Your answer
Student ID#:
Your answer
Phone Number of the person being reported: *
Your answer
Select what applies: *
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